Ultrasound-Navigated Manta Deployment After Removal of Extracorporeal Membrane Oxygenation Cannula

Dahlbacka, Sebastian; Vähasilta, Tommi; Moriyama, Noriaki; Vainikka, Tiina; Aho, Pekka; Laine, Mika

doi:10.1016/j.athoracsur.2020.01.064

Cited by 13 publications

(11 citation statements)

References 6 publications

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“…However, the ultrasound method enables operators to confirm the toggle position appropriately even without pre-measurement. Therefore, the use of the ultrasound method may be effective for this situation, as reported previously by Dahlbacka et al 32 For the same reason, the US-MANTA technique could also be useful as a bail-out method for torrential bleeding post-failure of pre-closure with suture-based VCDs as long as the procedure wire is left within the complicated vessel. Moreover, it is important to investigate when to perform an endovascular therapy instead of surgical repairment, as bail-out in the case of MANTA deployment failure.…”

Section: Discussionmentioning

confidence: 60%

Incidence and Predictors of Access Site Vascular Complications Following Ultrasound-Guided MANTA Closure Deployment

2021

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Purpose: There is no report on the reproducibility of the ultrasound-navigated MANTA deployment (US-MANTA) technique and little is known about predictors for US-MANTA-related vascular complication (VC). This study aimed to assess the incidence and predictors of access-site VC using the US-MANTA technique and report insights of MANTA-related VC from consecutive cases following large-bore arteriotomy. Materials and Methods: Consecutive patients who underwent transfemoral transcatheter aortic valve replacement with the US-MANTA technique from November 2018 to February 2020 were evaluated. MANTA-related VC was defined as access-site complications leading to major or minor VCs based on Valve Academic Research Consortium-2 criteria. Results: Among 378 patients, 23 cases (6.1%) of MANTA-related VC (major VC: n=7 [1.9%], minor VC: n=16 [4.2%]) were identified. No significant difference was observed in the incidence of MANTA-related VC over the observational period (first quartile: 5.3%, second: 5.4%, third: 7.4%, and fourth: 6.3%, p>.50). In 7 patients with MANTA-related major VC, 4 (57.1%) of complications resulted from incomplete apposition of the toggle due to anterior wall calcification of the common femoral artery (CFA). Anterior calcification of the CFA determined by computed tomography was identified as an independent predictor of MANTA-related VCs. Conclusions: The US-MANTA technique sustainably provides a low rate of access-site VCs following large-bore arteriotomy. Incomplete apposition of the toggle due to anterior calcification of the CFA may lead to ongoing vascular and bleeding complications.

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Section: Discussionmentioning

confidence: 60%

Incidence and Predictors of Access Site Vascular Complications Following Ultrasound-Guided MANTA Closure Deployment

2021

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“…This is achieved by measuring the skin to artery depth with ultrasound or computed tomography. Another recently described appealing technique to decrease this risk is deployment of the MANTA device under simultaneous ultrasound‐guidance, 13,14 however, this technique was not applied in the current series.…”

Section: Discussionmentioning

confidence: 98%

Percutaneous decannulation of extracorporeal membrane oxygenation using a plug‐based closure device

Dalén

Settergren

Kastengren

et al. 2022

Cathet Cardio Intervent

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Background: There is limited experience of using the MANTA plug-based vascular closure device for percutaneous arterial closure of the femoral artery after venoarterial extracorporeal membrane oxygenation. Objectives: To study femoral artery complications and need for subsequent vascular interventions after percutaneous decannulation of venoarterial extracorporeal membrane oxygenation (VA ECMO) using the MANTA plug-based vascular closure device. Methods: We studied 34 consecutive patients who underwent percutaneous decannulation of VA ECMO using the MANTA device. Primary outcomes were conversion to surgical cutdown of the groin at decannulation (immediate) or later. Secondary outcomes were type of vascular complication necessitating conversion to surgical cutdown of the groin. Results: Six (17.7%) patients had to undergo immediate (n = 3) or late (n = 3) conversion to surgical cutdown of the groin. Of these, three were owing to occlusion of the common femoral artery resulting in insufficient distal perfusion and three owing to bleeding or pseudoaneurysm. The mechanism of failure was complete intravascular deployment of the MANTA device in three patients, incomplete MANTA sealing of the arteriotomy in one patient, MANTA-unrelated thrombotic occlusion in one patient, and unknown in one patient. Surgical cut-down was typically performed with concomitant catheter thrombectomy with or without patch reconstruction of the artery. Conclusion: Percutaneous decannulation of VA ECMO using the MANTA VCD was feasible but a substantial number of patients needed to be converted to unplanned surgical repair, owing to either closure site-located stenosis/occlusion or bleeding. If suboptimal MANTA positioning is suspected, a low threshold for conversion to surgical cutdown of the groin is recommended.

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“…A detailed investigation of the MANTA device as a bail-out option is currently missing. [31][32][33]. However, comparative and randomized studies are still lacking in this setting and could therefore not be included in this meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Comparison of plug-based versus suture-based vascular closure for large-bore arterial access: a collaborative meta-analysis of observational and randomized studies

et al. 2023

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Background Large-bore arteriotomies can be percutaneously closed with suture-based or plug-based vascular closure device (VCD) strategies. The efficacy of both techniques remains controversial. Aims We conducted a meta-analysis of comparative studies between both VCD strategies, focusing on the most commonly applied VCDs (MANTA and ProGlide). Methods We searched MEDLINE, the Cochrane Central Register of Controlled Trials and Google scholar for observational studies (OS) and randomized controlled trials (RCT) comparing vascular closure with the MANTA-based and the ProGlide-based technique. The principal endpoint of this analysis was access-site related vascular complications. Both study types were analyzed separately. Results Access-site related vascular complications were less frequent after vascular closure with the MANTA technique in the analysis of OS (RR 0.61 [95%CI 0.43–0.89], p = 0.01, I2 = 0%), but more frequent in the analysis of RCT data (RR 1.70 [95%CI 1.16–2.51], p = 0.01, I2 = 0%). Both data sets provided no significant difference between the VCD techniques in terms of overall bleeding events (OS: RR 0.57 [95%CI 0.32–1.02], p = 0.06, I2 = 70%; and RCT: RR 1.37 [95%CI 0.82–2.28], p = 0.23, I2 = 30%). RCT data showed that endovascular stenting or vascular surgery due to VCD failure occurred more often after MANTA application (RR 3.53 [95%CI 1.07–11.33], p = 0.04, I2 = 0%). Conclusions While OS point to favorable outcomes for large-bore vascular closure with the MANTA-based technique, RCT data show that this strategy is associated with more access-site related vascular complications as well as endovascular stenting or vascular surgery due to device failure compared with the ProGlide-based technique. Graphical abstract

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Ultrasound-Navigated Manta Deployment After Removal of Extracorporeal Membrane Oxygenation Cannula

Cited by 13 publications

References 6 publications

Incidence and Predictors of Access Site Vascular Complications Following Ultrasound-Guided MANTA Closure Deployment

Incidence and Predictors of Access Site Vascular Complications Following Ultrasound-Guided MANTA Closure Deployment

Percutaneous decannulation of extracorporeal membrane oxygenation using a plug‐based closure device

Comparison of plug-based versus suture-based vascular closure for large-bore arterial access: a collaborative meta-analysis of observational and randomized studies

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